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Background  To evaluate differences in the clinical characteristics and molecular pathology of lung adenocarcinoma subtypes as defined by the new  I nternational  A ssociation for the  S tudy of  L ung  C ancer/ A merican  T horacic  S ociety/ E uropean  R espiratory  S ociety international histological classification.    Methods  We retrospectively reviewed 269 patients with initial primary lung adenocarcinoma who had undergone complete resection at our department from  A ugust 2013 to  D ecember 2014, focusing on the new histologic subtype classification, clinical characteristics, and molecular pathology.    Results  All specimens were invasive adenocarcinoma, and were lepidic (13.0%), papillary (19.7%), acinar (51.7%), solid (8.6%), micropapillary (1.1%) or mucinous predominant (5.9%). Epidermal growth factor receptor (  EGFR  ) mutations were detected in 132 cases (60.3%). Female patients and non‐smokers had higher   EGFR   mutation rates ( P  = 0.022 and 0.026, respectively). The lepidic, papillary, acinar, solid, micropapillary, and mucinous predominant patterns had   EGFR   mutation rates of 70.6%, 64.8%, 72.5%, 33.3%, 100%, and 5.9%, respectively. The exon mutation distribution differed according to serum carcinoembryonic antigen ( CEA ) levels ( P  = 0.018). v‐ K i‐ras2  K irsten rat sarcoma viral oncogene homolog (  KRAS )  mutations were detected in 20 cases (9.2%), and were frequently found in the mucinous and solid predominant subtypes. The serum  CEA  levels differed among the subtypes.    Conclusions  In  C hina, there are significant differences between lung adenocarcinoma histologic subtypes. The presence of well‐differentiated components in lung adenocarcinoma indicates higher   EGFR   mutation rates; the presence of solid or mucinous components indicates higher   KRAS   mutation rates. Serum  CEA  levels are associated with histologic subtype and   EGFR   exon mutations.

Identification of lung adenocarcinoma mutation status based on histologic subtype: Retrospective analysis of 269 patients